The author is a Forbes contributor. The opinions expressed are those of the writer.

Loading ...

Loading ...

This story appears in the {{article.article.magazine.pretty_date}} issue of {{article.article.magazine.pubName}}. Subscribe

When Andrew Cuomo and Chris Christie, the governors of New York and New Jersey, announced that they would be putting in place an enforced quarantine when medical workers who had contact with Ebola in Liberia, Sierra Leone, or Guinea enter the United States, my immediate reaction was that this was a bad decision. The reason: it would make it practically impossible to for doctors to volunteer to go to those places and risk their lives to try to help end the epidemic. That they reportedly didn't even consult their health commissioners made me feel worse.

I wasn't the only one who thought that, of course. Arthur Caplan, the NYU Langone Medical Center bioethicist, wrote a piece suggesting that if we're going to lock docs up, it should at least be in a nice hotel with wine and Wi-Fi. And Paul Offit, chief of the division of infectious diseases at Children's Hospital of Philadelphia, wrote in an email to me:

If someone is afebrile and asymptomatic, they aren't contagious.

The New York city doctor acted in a responsible manner. The minute he noticed his first symptom (temperature of 100.3 degrees) he quarantined himself. The people who are at risk of catching Ebola in the United States are ICU workers taking care of patients who are vomiting and have diarrhea, bodily fluids which contain large amounts of virus. The Dallas patient was intubated and dialyzed, two procedures that put those taking care of him at risk. His fiancee, on the other hand, who was with him earlier in his illness, never caught the virus, even though she likely kissed him and slept with him.

But not everyone agrees. I also contacted Pascal J. Imperato, the Dean at SUNY Downstate Medical Center and former New York City Health Commissioner. He surprised me with the strength of his response. His basic response to the idea that fewer volunteers will be going to Africa is to say that maybe volunteers aren't that effective anyway, and that their lack of actual experience may make them more likely to catch Ebola. Imperato writes:

I strongly support the decision by New York and New Jersey to quarantine those entering these states who have been exposed to those with active Ebola disease infections in Africa. This especially applies to volunteer US health care workers who have been providing health care to Ebola patients in Liberia, Guinea, and Sierra Leone. As demonstrated by the case of Dr. Craig Spencer, self-monitoring simply does not work. The New York and New Jersey quarantine regulations are timely since they address the next phase in the control and prevention of this epidemic, and that is the responsible management of returning medical volunteers and others with a history of close contact with Ebola patients.

I would add that while the willingness of such volunteers to go to West Africa is admirable, good intentions are no substitute for competent practice and experience in caring for Ebola patients. Most American medical volunteers working in the epidemic zone are there short-term, their pre-departure preparation excellent to uneven, and their previous experience in treating patients with a highly communicable and deadly disease often non-existent.

The Centers for Disease Control and Prevention has hesitated to implement the quarantine regulations now in force in New York and New Jersey out of a concern that they will discourage medical volunteers from going to the epidemic zone in West Africa. However, such a position is based on an unproven assumption that these volunteers are vital to the treatment of Ebola patients. This assumption has not yet been supported by firm evidence. A revolving door of short term and quickly trained American volunteers leaves many understandably uncomfortable since they are often trained, but not practice experienced. It is the latter that is crucial in preventing care givers from acquiring this infection in a therapeutic setting.

Those are strong words. But if we can't send volunteers, because they won't learn infection control procedures fast enough, what do we do? The thing that most increases the odds of Ebola coming here is for the epidemic in West Africa to become larger. It doesn't matter how hard you try to stop up the drain, if you keep pouring water in, it's going to leak or burst. Are we just forced to hope the epidemic burns itself out, or to wait for vaccines to be developed by GlaxoSmithKline, Johnson & Johnson, Inovio, or Newlink? We just sit and wait as things get worse? That seems...that is terrible.

We do need to make sure that one Ebola case here does not turn into many, or, God forbid, to allow the virus to take up residence here. But it does seem, from both Imperato's previous comments to me and Offit's, that the risk of infection for Americans remains vanishingly low. Probably 1,000 people died of methicillin resistant staphylococcus aureus in our hospitals since Ebola first showed up in the U.S. It's true that Ebola could become a much bigger problem. It's an infectious disease, and it can spread. But I worry that our panic is both not addressing the core problems that make us bad at infection control and distracting us from actually figuring out ways to deal with this problem.

I don't know how to feel on the quarantine, which, I suppose leaves me in the position of acceding reluctantly to its existence. But I do hope that we've got better solutions than travel bans and quarantines, because these don't fill me with confidence.